Triglyceride values after six months of lopinavir/ritonavir therapy as an indicator for pancreatitis risk

Abstract

Pancreatitis is the inflammation of the pancreas with varying aetiology. Hypertriglyceridaemia (HTG) is known to cause pancreatitis at triglyceride (TG) values of 11.3 mmol/L and beyond. The protease inhibitors (PIs) - a class of antiretroviral drugs that form part of some triple drug regimens indicated for the treatment of infection with the human immunodeficiency virus (HIV) - are known to induce HTG. Lopinavir/ritonavir (LPV/r) is the PI combination in a single dosage form that was relevant to this study. The primary aim of this study was to investigate the risk of pancreatitis after the first six months of LPV/r therapy. The study included adult patients, treated at the Centre for Disease Control (CDC) at a public regional hospital in KwaZulu-Natal, older than the age of 18 years that were on LPV/r-based therapy (n=194). Data collected were TG values, serum (s)-amylase values and CD4 counts after the first six months of LPV/r therapy. Risk was determined by the probability of pancreatitis in the study sample. Association between the cases of pancreatitis and cases of HTG was tested by a chi square statistical test. The chi square test was also used to determine whether there is an association between gender and pancreatitis and CD4 count and pancreatitis. No cases of pancreatitis were detected in the study sample. The mean triglyceride values (standard deviation [SD]) were 1.94 mmol/L (1.30). The mean s-amylase levels (SD) were 111.00 U/L (46.38). Both TG and s-amylase mean values were notably increased and there was a clear tendency to increase for both triglyceride levels and s-amylase levels. The mean CD4 count (SD) was 364.76 cells/μL (226.85). There was a statistically significant difference between the mean TG values (SD) of males (n=50) and that of females (n=144) at 2.36 mmol/L (1.74) and 1.79 mmol/L (1.08) respectively. There is therefore negligible risk of pancreatitis after the first six months of LPV/r therapy. However, the elevated mean triglyceride values may still warrant intervention and continuous monitoring, especially for the male population